Raising Self-Esteem and Teaching New Coping Mechanisms

After writing a few posts on the intricacies of complex anorexia care, it seems fitting to talk about a more global concern: the poor body image and low self-esteem that go hand-in-hand with an eating disorder.

Eating disorders, write McShane and Paulson, can be many things: A way to feel secure, a way to make life feel predictable, a means of communicating emotions, a way to simulate the calming sense of "being in control" for the person who feels his life is completely out of control. Eating disorders, in other words, are a solution to that feeling of not being "good enough." Eating disorders become a cherished coping mechanism.

I recently came across another explanation/interpretation of the eating-disordered mindset, in Eckhart Tolle's A New Earth: Awakening to Your Life's Purpose. "In the West, it is the physical appearance of the body that contributes greatly to the sense of who you think you are: its strength or weakness, its perceived beauty or ugliness relative to others...Many feel a diminished sense of self-worth because they perceive their body as ugly or imperfect."

Leaving aside the fact that there are plenty of people in the eastern hemisphere who feel inadquate because of their outward appearance, Tolle captures a common feeling that describes nearly everyone as well as the severly eating disordered. He attributes this faulty perception to being overly "mind-identified," a condition in which one's ego is in the driver's seat and fails to see that the real essense of a person does not lie in a body "destined to grow old, wither and die," but in "the formless dimension, the light of consciousness" that "can shine more easily through the fading form."

He's not completely fixated on conscious awareness and non-being, though, allowing that "If [one's body] is strong, beautiful, or vigorous, you can enjoy and appreciate those attributes--while they last. You can also improve the body's condition through right nutrition and exercise." Tolle adds, "If you don't equate the body with who you are, when beauty fades, vigor diminishes, or the body becomes incapaciated, this will not affect your sense of worth or identity in any way."

Tolle's remedy for egoistic body-identification is to focus on "the feeling of aliveness inside" the body rather than by obsessing about outward flaws. Instead of getting lost amid incessant negative mind chatter he advises focusing on a calming "inner body awareness." In its attempt to correct basic errors of perception, his approach shares some aspects of cognitive behavioral therapy, in which a therapist helps restructure the patient's erroneous assumptions about herself.

Drs. Herzog and Franko advise counseling a perfectionistic child to strive for "excellence, not perfection." They note, "Excellence is achievable; perfection isn't."

In our book, Marcia and I note that low self-esteem is the most potent risk factor for both disordered eating and a full-blown eating disorder. We advise trying to foster a sense of autonomy in your child, the feeling that she has control over important aspects of her life. Give her opportunities to succeed within in the family, such as playing a role in making important family decisions, or helping with at-home projets. Praise skill, achievement, mastery and personality traits such as kindness, generosity and fairness, not appearance. Teach your child to understand to identify his feelings, and understand that even those that are unpleasant or painful are legitimate. And instead of using food to soothe, calm or reward a child, offer him a hug instead of a cookie.

Not all people with anorexia nervosa have low self-esteem, and for those who do, it is not known whether low self esteem preceded AN, or whether AN caused the low self esteem. Furthermore, it is likely that low esteem is the product of the semi-starvation that accompanies AN. In the Minnesota Starvation Study, the subjects were psychologically healthy before they were semi-starved. Once they lost a signficiant amount of weight, however, they became anxious, depressed, and suffered from low self esteem. These symptoms lifted when the subjects in the experiment became renourished. Similarly, most people with AN revert to their old selves once they are renourished.

There is no evidence that teaching children to understand or identify feelings will either prevent or successfully treat anorexia nervosa. Nancy, do you have objective evidence for your assertions in this article?

Hey There,
I have taught kids for a number of years and seen self-esteem pinned to all sorts of things like clothes, who has the latest gadget, who likes them... all these external and superficial things that children have little control over - including to a large degree what they look like. It made me worry that kids didn't know what to base their sense of worth on. I started using this program called Who Is NOBODY? (www.whoisnobody.com) that got kids to figure out what they are interested in and then make a difference - for example, if you love animals and love to paint the kids would make a poster to collect blankets to donate to an animal shelter... I found it an effective way to get kids focused on their identity by taking action - something they have control over, rather than hoping things out of their control fall into place - like that so-and-so is nice to them that day! I love how you say to get kids to focus on excellence vs. perfection and I saw first hand how it changed the whole dynamics of my classroom! Great article Nancy Matsumoto! Thanks, Kellywww.the10principles.com